Nursing home bedsores are all too common in California. It's nursing staff--nurses and aides -- who are the most important people to help prevent and heal pressure ulcers. Yet nursing homes operating in California care often chronically understaffed, placing residents at significant risk of developing bedsores.
Does a Bedsore Mean the Nursing Home was Negligent?
Bedsores are often a sign of nursing home neglect and abuse. Nursing homes must make sure that residents who are at risk for developing pressure ulcers are provided adequate care and services to prevent the development of bedsores. If they do not, the nursing home was negligent.
Nursing homes must also provide adequate care to residents who have bedsores to promote healing and prevent bedsore infection. If they do not, the nursing home was negligent.
There are times when someone is so sick that bedsores are impossible to avoid. The federal regulations call these bedsores “clinically unavoidable.” However, nursing homes have to take every precaution and provide every available treatment before a bedsore can be classified as "unavoidable". The vast majority of bedsores can be avoided if the nursing home is properly staffed and takes the appropriate precautions.
If a bedsore was preventable, there is likely negligence. Contact us now to discuss starting an investigation.
Is a Bedsore the Same Thing as a Pressure Ulcer, Pressure Wound, Skin Wound, or Decubitus Ulcer?
Yes, the term “bedsore” is just a common way to refer to pressure ulcers, also called pressure wounds, and decubitus ulcers. They are all just ways to describe skin wounds caused by pressure, shear, or friction.
A bedsore is damage to an area of the skin and underlying tissues usually caused by pressure over a bony area. There are multiple layers of tissue between surface skin and our bones, and they can be damaged by pressure, sideways pulling (“shear” force), or friction.
Because they often develop into where the tissue is compressed between a bony part of our body and a bed, they are called “bed sores.” But they do not have to be caused by a bed, and sometimes never develop into an open sore at all.
How Do I Know if I Need a California Bedsore Lawyer?
You know you need a California bedsore lawyer if: (1) a bedsore is allowed to grow to a Stage IV bedsore; (2) there are multiple, serious, or large bedsores; (3) the bedsores become infected; or (4) the bedsores lead to sepsis or death.
You may never be told how serious a bedsore became, or even that the bedsore became infected or led to sepsis and death. Sometimes that's because the nursing home just does a bad job of communicating. Sometimes it is part of a cover-up.
A California nursing home lawyer can investigate and help determine if the bedsore--or other nursing home neglect or abuse--led to the death.
We represent families against some of the largest California nursing home companies. These can be long, expensive lawsuits that take a lot of time and energy but sometimes the only way to hold the nursing home accountable for the injuries they have caused is to fight them in court.
Contact us now to discuss starting an investigation.
What are Common Areas of the Body for Bedsores?
Because bony areas allow more pressure on the skin and tissues, bedsores are most commonly formed over bony areas.
The most common areas for bedsores are the lower back (the sacrum) and tailbone (coccyx), on our feet (the heels), and around our pelvis bone (the hips). Other less common areas for bedsores include the elbows, knees, ankles, back of shoulders, and back of our head (or “cranium”).
If a person has assistive devices like a leg or arm brace, the pressure of hard edges or friction against the skin can cause bedsores in those areas.
What are Common Causes of Bedsores?
The most common cause of bedsores is prolonged pressure from being left in the same position in a bed or wheelchair.
Pressure ulcers occur due to pressure applied to soft tissue. Pressure cuts off or reduces blood flow to the tissue cells, the cells need the blood flow to stay alive. Not having enough blood causes tissue cells to die, leaving dead areas that can open into gaping wounds.
Sideways forces--shear--can also cause ulcers, by pulling between layers and damaging the tissues. Shear can also tear the blood vessels that feed the skin.
Pressure ulcers are most common in older people who are not moving and changing position much. This could be because they are confined to a bed (“bedridden”) or a wheelchair and cannot easily change position on their own.
Other major factors in bedsore development include malnutrition (especially too little protein or calories), dehydration (causing skin weakness and stress on the organs that help keep skin healthy), skin wetness (from being left in wet undergarments, or sweating), diseases that reduce blood flow to the skin.
Bedsore healing can be more difficult because of age, medical conditions like diabetes or infection, and medications like anti-inflammatory drugs.
Contact us now to discuss starting an investigation.
How are Nursing Homes Supposed to Prevent or Treat Bedsores?
Nursing homes are required under federal and state regulations to provide appropriate care to minimize the development of bedsores, and treat and prevent bedsores from becoming infected.
Under Federal Regulations governing nursing homes, § 483.25(c):
(c) Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that—
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.
Some of the tools nursing homes have to prevent bedsores include:
- Using special bedsore mattress pads, like air mattresses
- Using pillows or pads to protect and reduce pressure on bony areas
- Using special pads for sitting in chairs to reduce pressure
- Turning and repositioning residents at least every 2 hours to avoid pressure buildup
- Using creams and ointments to prevent skin breakdown, especially with skin that is exposed to urine and feces in incontinent residents
- Good nutrition and hydration
Some of the tools nursing homes have available to treat bedsores include:
- Cleaning and cleansing a bedsore with sterile solutions
- Packing an open wound bedsore, or covering with a dressing
- Surgically removing dead (“necrotic”) or diseased skin (called “debriding” a bedsore wound)
- Increased calorie and protein intake, including supplement shakes
- More frequent turning and repositioning (“offloading”)
- Antibiotics to treat infections of the wound or other infections that could delay healing
Nursing homes are required to know and implement bedsore interventions to prevent or treat bedsores. Whether they bother, or implement them correctly, is a different matter.
If you want us to investigate your case and determine if the nursing home was negligence, contact us now to discuss starting an investigation.